Published on in Health Tip of the Week
Is your 5-year-old still eating the same three foods she’s liked since age 2 — and little else? Do you worry she’ll be off to college some day and still never know the joys of fruits or vegetables?
You’re not alone. “I’ve worked with children and parents for 12 years, and parents of picky eaters are among the most miserable, and the older their picky eater gets, the more worried they become about their child's future,” says Katherine Dahlsgaard, PhD, ABPP, clinical director of the Anxiety Behaviors Clinic and the Picky Eaters Clinic in CHOP’s Department of Child and Adolescent Psychiatry and Behavioral Sciences.
“It is heartbreaking for parents when their kids don’t enjoy family meals, eat like all the other kids at birthday parties, or participate in big celebrations like Thanksgiving,” she says.
With the right treatment, however, even extremely picky eaters can successfully broaden the range of foods they eat comfortably. The key, says Dr. Dahlsgaard, is treatment that involves and empowers the parents. In fact, Dr. Dahlsgaard just published the results of her treatment program for picky eaters in a recent issue of Cognitive and Behavioral Practice.
Through this brief treatment — based on the principles of exposure-based cognitive-behavioral therapy (CBT) — parents themselves are trained to coach their children to try new foods on a daily basis.
We asked Dr. Dahlsgaard for her “do’s” and “don’ts” when it comes to feeding picky eaters — and how to tell when it’s time to seek professional help.
- Do remember that picky eating is often “developmentally normal.” Children across the globe go through a picky eating phase from about age 2 to about age 4. “We think it starts out partly as a built-in protective impulse in a child. When a toddler can wander off out of a caregiver’s sight and potentially pick things off the ground to put into his mouth, Nature has instilled in him a wary sense that says, ‘This is a new ‘food,’ and I won’t like it,’” she says.
- Don’t blame yourself. “Most picky eating cannot be explained by poor parenting. The proof for that is that many picky eaters have siblings who eat just fine,” says Dr. Dahlsgaard. “So I let parents know their child probably came into the world with a brain that is just more rigid about trying new foods. I ask parents of picky eaters to allow some compassion for themselves about how frustrating that is,” she adds.
- Don’t give up on a new food! Try over and over again. The reason: Research says it takes eight to 15 times to introduce a new food before your child will accept it. Yet parents typically offer a food three to five times before deciding their child is never going to like it.
- Do make sure your child comes to the table hungry. “Often, parents aren’t even aware of how frequently their child eats and drinks,” says Dr. Dahlsgaard. “Have your child wait two hours between a snack and mealtime, and one hour between a drink and mealtime,” she says.
- Don’t fear your child’s hunger. “Lots of parents worry about their child feeling hunger pangs. They offer a quick snack, or give in to a demand, to relieve any such discomfort. But it’s OK for your child to feel hungry; he’s not starving. Being hungry means he’s looking forward to the next meal,” says Dr. Dahlsgaard.
- Do set limits around food and talk in a matter-of-fact tone. “Many parents are very shy about setting limits around food in a way they’re not shy about setting bedtime limits, for instance,” says Dr. Dahlsgaard. “In a neutral tone, you might say something like: ‘You need to eat a bit of this in order to have dessert.’ You don’t need to yell or show emotion other than a little optimism. And if your child doesn’t eat it, don’t react, but be sure to follow through on withholding dessert. It’s just the consequence of not tasting a food. You should also avoid talking about it later and instead move on with your evening,” she says.
- Do establish mealtime routines. Try to eat your dinner around the same time every night; keep distractions like phones and TV out of mealtime; talk about pleasant topics so kids associate positive feelings with mealtime. “Remember that kids get the vast majority of their calories in the first 20 minutes, so set a happy tone to start the meal and keep time at the table short to avoid boredom,” says Dr. Dahlsgaard.
- Don’t be afraid to ask for help. Severe picky eaters may need extra help from a professional to move beyond their limited eating choices. Prior to age 15, children often aren’t motivated to change. “They’re not unhappy about their picky eating, only their parents are,” says Dr. Dahlsgaard. How can you tell if your child’s habits are severe? Look for signs such as:
- Being extremely unwilling to taste any new food, even after having it on her plate multiple times.
- Extreme distress about food your child doesn’t prefer; for instance, she may avoid all bagels because she once found a seed on her bagel that she wasn’t expecting.
- Developing aversions to foods she used to eat.
If you think your child is a severe picky eater, be sure to seek out a professional who has extensive experience treating the problem. At CHOP, psychologists like Dr. Dahlsgaard can help parents faced with this issue learn to use a method that rewards children for trying different foods and adding new options to their diet.
“Children should learn how to overcome extreme picky eating not just for the sake of their physical health, but for a greater sense of well-being. Eating a range of foods and enjoying a meal are critical to a well-lived life,” adds Dr. Dahlsgaard.
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